Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Respirology. 2011 Apr;16(3):487-94. doi: 10.1111/j.1440-1843.2011.01945.x.
The aim of this study was to investigate the time course, and correlation with prognosis, of BAL fluid concentrations of soluble triggering receptor expressed on myeloid cells (sTREM-1) in patients with ventilator-associated pneumonia (VAP).
The study included 35 patients with clinically diagnosed VAP, eight of whom were BAL fluid culture-negative and 27 BAL fluid culture-positive (16 survivors, 11 non-survivors). sTREM-1 levels were measured in BAL fluid of these mechanically ventilated patients, at the time of diagnosis, on days 4-5 and on days 7-9. The time course of this biomarker and its prognostic value for outcome in patients with culture-positive VAP were assessed.
sTREM-1 concentrations were significantly greater in culture-positive VAP patients than in culture-negative VAP patients. sTREM-1 levels decreased significantly with time in surviving patients with culture-positive VAP, but increased significantly with time in non-survivors. In contrast, PaO(2)/fraction of inspired oxygen (FiO(2)) increased significantly with time in survivors and decreased significantly with time in non-survivors. At a cut-off value of -10 pg/mL 7-9 days after initial diagnosis, sTREM levels had a sensitivity of 90% and a specificity of 87.5% for predicting mortality.
sTREM-1 concentrations in BAL fluid are of potential prognostic value in patients with VAP.
本研究旨在探讨呼吸机相关性肺炎（VAP）患者支气管肺泡灌洗液（BAL）中可溶性髓系细胞触发受体-1（sTREM-1）的时间进程及其与预后的相关性。
本研究纳入了 35 例临床诊断为 VAP 的患者，其中 8 例 BAL 液培养阴性，27 例 BAL 液培养阳性（16 例存活，11 例死亡）。对这些机械通气患者的 BAL 液进行 sTREM-1 水平检测，分别在诊断时、第 4-5 天及第 7-9 天进行。评估了该生物标志物的时间进程及其对培养阳性 VAP 患者结局的预后价值。
培养阳性 VAP 患者的 sTREM-1 浓度明显高于培养阴性 VAP 患者。存活的培养阳性 VAP 患者的 sTREM-1 水平随时间显著降低，而非存活者的 sTREM-1 水平随时间显著升高。相比之下，存活者的 PaO2/吸入氧分数（FiO2）随时间显著升高，而非存活者的 PaO2/FiO2 随时间显著降低。在初始诊断后 7-9 天的 -10 pg/mL 截断值下，sTREM 水平预测死亡率的敏感性为 90%，特异性为 87.5%。
BAL 液中 sTREM-1 浓度对 VAP 患者具有潜在的预后价值。
